In most societies, mothers are the primary providers of care to young children. This is a demanding task and the mental health of a mother is not only essential to her well-being, but that of her child’s physical health, nutrition and psychological well-being. However, most child development programmes do not adequately address maternal mental health.
Recent research has shown that about 20% of mothers in developing countries experience some form of mental health problems during or after childbirth. The United Nation’s Secretary-General António Guterres has recently acknowledged that the issue of mental health remains a largely neglected issue and announced the UN’s commitment to “working with partners to promote full mental health and well-being for all”.
Moreover, professionals in the field are pointing out that the mental health of mothers is critical to the success of the UN Sustainable Development Goals on health, nutrition and gender equality (SDG 3, 2 and 5).
In South Africa, the rate of pregnant and postnatal mothers suffering from common mental disorders (depression and/or anxiety) can reach up to one in three. Many of them are poor, come from disadvantaged communities and face many obstacles in accessing services and care.
Across Africa, the majority of women experiencing challenges to their mental health during the perinatal period (pregnancy and up to one year after the birth) are also exposed to gender-based violence, economic and gender inequalities, physical illnesses (including HIV), complications of childbirth and the stresses of childcare. Suicide has been identified as one of the leading causes of maternal death worldwide.
Unfortunately, health care systems in most African countries are not equipped to deal with the complex health and social challenges faced by most mothers. With competing physical health priorities and constrained resources, mental health care remains seriously neglected.
To challenge the status-quo and to improve the mental health of mothers in Africa, a group of individuals and organisations are working together in the newly established African Alliance for Maternal Mental Health (AAMMH).
AAMMH believes that a multi-sectoral approach is needed to tackle the causes of poor maternal mental health in Africa. The alliance calls for the integration of existing evidence-based interventions for the detection, prevention and treatment of maternal mental health problems into reproductive and child health programmes, supported by mental health services with specialist expertise.
This call for action is very close to the PMHP’s mission to develop and advocate for accessible maternal mental health care that can be delivered effectively in low-resource settings. We have thus become involved with the Global Alliance for Maternal Mental Health (GAMMH) over the past year since its formation and are now a proud founding partner of its first regional off-shoot, the AAMMH.
Together with colleagues in Malawi, we have been preparing for the upcoming launch on the 19 June in Lilongwe, Malawi. Prior to the launch, we will conduct a training workshop with health care providers and managers in maternal, mental and child health. On the launch day itself, we will be delivering a keynote address sharing the experience of the PMHP and will also be conducting a workshop towards establishing strategies for working partnerships across sectors for maternal mental health.
We hope our experience and work in South Africa, and in other low and middle-income countries, will contribute to the development and growth of this pan-African advocacy initiative. At the same time, we look forward to collaborating and learning from advocates, practitioners, trainers and researchers across Africa to strengthen the work we do in South Africa.
AAMMH will be officially launched in Lilongwe, Malawi on 19 June 2018. You can follow the event by using the hashtag #AAMMH #GAMMH
Read more about aims and objectives of the AAMMH here.
Source: Maternal Health Task Force blog
Diagnosis gap in Low- and Middle-Income Countries (LMICs)
Despite contributing significantly to maternal deaths and unproductive life years, common perinatal mental disorders (CPMD) often go undetected among women in low-resource regions. This can mean that up to 80% of women remain untreated in such settings. Resource-constrained primary care centers, high patient volumes, lack of recognition by health workers as well as increased task shifting to semi-skilled health workers contribute to this treatment gap. In order to encourage timely identification of CPMD among mothers followed by referrals, antenatal care provision centers are a promising platform in LMICs due to the high level of touchpoints between expectant women and health systems. In South Africa, for example, a mother’s contact rate with any antenatal care facilities is quite high at approximately 91%. […]
Lead author Thandi van Heyningen shares insight into progress and next steps for improving maternal mental health in low-resource settings:
“Where health system resources are scarce, one way of improving detection and improving access to treatment, is to integrate these services into existing, routine, primary health care services using a stepped care approach. Improving detection through routine antenatal screening may provide a vital first step, however there is a need to generate further evidence on the feasibility and acceptability of existing screening tools for use in such settings, and by non-specialist health care workers.”
Perinatal depression and anxiety are serious mental health problems and are among the leading causes of maternal morbidity and mortality worldwide!
Pregnant women are at higher risk for suicidal ideation and behaviours compared to the general population.
Suicide has been identified as one of the major contributors to the global mortality burden and there is a growing concern over the increase in suicidal ideation and behaviour among pregnant women.
Studies in low- and middle-income countries put the rate of maternal death due to suicide at somewhere between 0.65% and 3.55%. In such cases, risk factors include poverty, lack of support, lack of trust in health systems and coexisting mental illnesses.
Suicidal thoughts experienced during pregnancy can continue beyond the initial postpartum period, affecting the well-being of both mother and child.
More about pregnancy and suicidal ideation in our infographic
The negative cycle of mental ill-health and poverty is particularly relevant for women and their infants during the perinatal period. During this time, major life transitions render women more vulnerable to mental illness from social, economic and gender-based perspectives.
Those with the most need for mental health support, have the least access. Overburdened maternal and mental health services have not been able to address adequately this significant unmet need. There have been limited attempts at a programmatic level, to integrate mental health care within maternal care services.
The perinatal period, where women are accessing health services for their obstetric care, presents a unique opportunity to intervene in the event of mental distress. Preventive work involving screening and counselling may have far-reaching impact for women, their offspring and future generations.
Mental health care is a notoriously neglected area – even more so in “healthy” pregnant and postnatal women. The focus on the physical to the detriment of the emotional is particularly felt now against the backdrop of HIV and AIDS. The public health service has been unable to address the mental health needs of women from poorer communities – neither within maternity services nor within mental health services. This is despite a wide body of evidence showing that distress in the mother may have long-lasting physical, cognitive and emotional effects on her children.
The PMHP aims to integrate mental health service routinely, within the primary maternal care environment.
Based at selected government MoU facilities in Cape Town, we offer counselling and support services focused on the emotional wellbeing of pregnant women with a strong focus on postnatal and clinical depression.
Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes.
Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development.
Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.
This research will provide much-needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low-resource settings that have a high prevalence of IPV and HIV.
Source: BMC Health Services ResearchBMC series
Follow the project: BioMed Central
The Royal College of General Practitioners has launched a new
Perinatal Mental Health Toolkit
The resources are designed to support GPs and healthcare professionals to support and deliver the care patients with perinatal mental health conditions need.
Furthermore it contains resources for mothers, fathers and an entire section on family support, self-care and well-being during and after pregnancy. This includes information leaflets for patients, and links to supporting charities and social media groups.
This toolkit offers a comprehensive and holistic approach to tackle the stigma of perinatal mental health problems!
More and more women are sharing their personal story with depression during or after pregnancy.
“Maureen had her first suicidal thought the morning she found out she was pregnant with her first son seven years ago.”
Her documentary Dark Side of the Full Moon
shares her story and the stories of several other women who suffered from postpartum depression.
Rosey is a mum of three, fighter of PND and founder of
#PNDHour She is also considered one of the leading campaigners for improving perinatal mental health services.
Every wednesday everybody can join, follow, and connect with others affected by perinatal mental illness on twitter. She also runs a very successful blog to share her story.
“Amelie suffered from postnatal depression when her son Zenon”
Inspired her story, a nurse and writer is bringing hard-hitting play Friction to the stage.
And there are many more inspiring women sharing their stories and raise awareness about perinatal mental health.
Inspiring compassion that will turn into action and one day every women will receive the mental health care they need.
Members of the Perinatal Mental Health Project (PMHP) presented to delegates at the International Marcé Society Biennial Scientific Meeting in Swansea and the World Congress of Psychiatry in Madrid last month. Here are some highlights and insights from our two presenters:
Presentation by Director, Simone Honikman
Simone was invited to speak about the PMHP as part of a symposium entitled “Born this Way: finding solutions to global challenges in Perinatal Mental Health”. The symposium convenor, Professor Carlos Zubaran, of the University of Western Sydney, had also arranged for speakers from Norway, Spain, Israel and Portugal to present. The PMHP presentation was unique in that our project was able to present solutions to high levels of depression and anxiety in contexts where resources are limited. The symposium was well attended, generated vibrant discussion as well as potential connections for future collaborations.
Read the abstract of the presentation ‘Maternal mental health and health service design‘ by Simone Honikman here: MMH_abstract
Presentation by Research Associate, Thandi van Heyningen
Thandi’s presentation was about screening for maternal depression and anxiety in a low-resource primary care antenatal setting in South Africa. She spoke about the use of various screening instruments as well as potential psychosocial risk factors. The results of this research from Hanover Park, have shown that a short, binary-scoring screening instrument that is easy to administer and score, performs as well as longer, more complex screening tools in detecting maternal anxiety and depression. The Whooley depression screen, which consists of two questions about mood symptoms and a third “help” question shows promise as a screening tool for the early detection of maternal depression and anxiety in these settings.
Read the abstract of the presentation: ‘Development of a mental health screening instrument for low-resource, primary-care antenatal settings in South Africa’ here: MentalHealthScreening_Abstract
We are pleased to share our 2014 Mid-Year report with our partners, friends and supporters.
This reports highlights some of the key achievements in our four programmes:
Teaching and Training,
Advocacy and Communications.